Medicare Seeks To Cut Number Of Seniors Denied Nursing Home Coverage After Hospital Stays

Posted by:  :  Category: Medicare

Rogue Magazine (October 1964)  Volume 9 Number 5 - Water Balloons ...item 1.. routinely use devious devices -- wears us down like rabid trial lawyers until we give in (August 15, 2011 / 15 Av 5771) ... by marsmet542Currently, if Medicare decides that a hospital has billed it for inpatient treatment of a patient who should have received observation services, the facility can lose its entire payment and is not paid for the cost the observation care. That may prompt hospitals to put too many people in observation care, Medicare says in the rule announcing the pilot program. Under the pilot, the 380 hospitals participating will be able to rebill Medicare for observation services if claims for inpatient care are rejected.  Medicare officials want to see if that takes some of the pressure off hospitals.
Source: kaiserhealthnews.org

Video: You Can Help Fight Medicare Fraud

Obama Tells Seniors They've 'Earned' Medicare and Social Security, Forgets to Note We Haven't Paid For Them

Social Security, meanwhile, certainly isn’t a guarantee. Obama might consider the retirement program a “bedrock commitment,” but the Supreme Court doesn’t. The court has ruled on two difference occasions that citizens are not entitled to the dollars they pay into the entitlement. Money paid into the program can be used to fund other totally unrelated government activities, just like any other tax dollars. The commitment to the program is dependent on the whim of politicians who are legally allowed to tax you for one thing and use that same money to pay for something else. That — and nothing else — is what seniors paying into Social Security have actually earned. 
Source: reason.com

As Medicare Fraud Evolves, Vigilance Is Required

Then there are more subtle abuses, the ones to which younger Medicare recipients may find themselves vulnerable. A patient with a mild case of high blood pressure, for instance, may be persuaded to undergo a battery of heart disease tests that are covered by Medicare but are not necessarily appropriate. “Patients shouldn’t feel pressured into unnecessary tests or treatments,” said Louis Saccoccio, executive director of the National Health Care Anti-Fraud Association, an advocacy group of insurers, law enforcement and regulatory agencies.
Source: hcafnews.com

Impact of Medicare Sequester v. Medicaid expansion on providers

Interestingly, the impact of the Sequester on health care providers is beginning to get some news coverage in North Carolina, but there has been very little discussion of the Medicaid expansion choice along the same lines, in the media or in the campaigns for Governor and General Assembly. I assume this means that the Republicans know that we will do the expansion in N.C., and they have wisely not boxed themselves in. It is not as clear to me why none of the Dems running are talking about this issue.
Source: samefacts.com

You’re a target: Boomers, seniors need to watch out for fraud

Couey warned consumers to be on the lookout for fake insurance companies that defraud consumers by collecting premiums for bogus policies with no intention of paying claims. These “companies” might offer policies at costs that are significantly lower than competitors’ prices, or they might be difficult to reach by phone – if a phone number is even listed.
Source: seattlepi.com

Ohio Health Policy Review: CMS estimates Medicare drug costs to jump in Ohio next year

The 1.8 million Ohioans covered by Medicare could pay more for prescription drugs next year, according to new data from the federal Centers for Medicare and Medicaid Serivices (Source: "Cost for many Medicare drug plans to increase in 2013," Akron Beacon Journal, Sept. 19, 2012).
Source: healthpolicyreview.org

On Shakespeare, the Fells, and Medicare

I recently returned from a blissful two weeks in the United Kingdom. My wife and I visited Edinburgh for the first time, London for the third, and spent a week in-between hiking around the intensely beautiful Lake District. Our hiking companions were truly remarkable. Our guide was in his mid-60s and could not have been fitter. For fun, he likes to walk across England from the North Sea to the Irish Sea. As this involves crossing both the Pennine Range and the Fells of the Lake District, this is no Sunday walk in the park! Our other hiking mates were an Australian in his mid 60s and a Californian in her late 70s. We hiked 3-5 hours daily with average elevation changes of nearly 1000 feet. My wife and I are in pretty good shape but our mates often walked circles around us.
Source: wordpress.com

Medicare debate dodges realities

• Second, the cuts will have real effects in real world. For Aurora Health, the biggest health system in Wisconsin, it will mean $78 million in revenue reductions. It’s revenue at the margin for the $4 billion non-profit corporation, and it’s always the revenue at the margin that has the biggest effect on profit or loss. Aurora is still trying to figure out how to cope with the revenue loss. In addition, there are another $20 million in Medicare nicks that Aurora faces next year.
Source: johntorinus.com

Administration: Health Law Led Medicare Beneficiaries To Save $4.5B On Rx Drugs

Posted by:  :  Category: Medicare

Stella Johnson On The Impact Of Health Insurance Reform by Leader Nancy PelosiUSA Today: Medicare Recipients Save $4.5 Billion On Prescriptions Medicare beneficiaries have saved a total of about $4.5 billion on prescription medications because of the 2010 health care law since January 2011, the Department of Health and Human Services plans to announce today. … The announcement comes two days after the Congressional Budget Office found that about 2 million more people than expected would be paying an average $1,200 penalty for not purchasing insurance as required by the law beginning in 2014. The number affected is significantly higher than the 4 million the CBO had estimated would pay a penalty in 2010, shortly after the bill passed (Kennedy, 9/21).
Source: kaiserhealthnews.org

Video: Medicare Part D Donut Hole

Study: Medicare Part D “donut hole” does not linked to increase in heart attacks

After a small deductible, Part D drug plans typically cover 75 percent of drug costs up to a certain dollar figure, which was $2,400 in 2007. After a beneficiary reaches that level, there is no coverage until the person has spent potentially thousands of dollars out of pocket, then coverage kicks back in.
Source: medcitynews.com

Candidates Differ Sharply on Medicare

ACA reduced the “Donut Hole” for Medicare prescription coverage. After an individual’s annual prescription costs reached $2,800, he or she had to pay out-of-pocket for the full cost of drugs up to $4,550. A combination of discounts and rebates reduced the impact, and under the ACA the gap is set to close by 2020, when there will no longer be a cap on Medicare prescription coverage.
Source: theepochtimes.com

Romney's Health Plan Would Have Impact on Current Retirees

Overturning President Obama’s health care law, as Mr. Romney has pledged to do, could wipe out several benefits that retirees are currently receiving because of the law. Chief among them are its provisions to help Medicare recipients pay for prescription drugs, to help cover the gap known as the “doughnut hole.” In the first eight months of this year, the Department of Health and Human Services said on Friday, the law helped the average recipient save $641 on drug coverage.
Source: nytimes.com

Paul Ryan booed, called a liar at AARP conference; read the President’s remarks

The problem is that insurance companies, once they’re getting vouchers, they’re really good at recruiting the healthier, younger Medicare recipients, and weeding out and leaving in traditional Medicare [to] the older, sicker recipients. And over time what happens is that, because there are older, sicker folks in the traditional Medicare plan, premiums start going up, they start going through the roof. And the entire infrastructure of traditional Medicare ends up collapsing, which means that all seniors at some point end up being at the mercy of the insurance companies through a voucher program. That’s what we’re trying to prevent. And the reason that AARP supported Obamacare and does not support this voucher approach is because they have looked at these independent experts and the analysis that they’ve put forward, and they know that a voucher program is not going to be a good deal for Medicare over the long haul. (Applause.)
Source: firedoglake.com

What Is the Medicare Donut Hole?

There are enhanced plans that provide additional benefits to help with donut hole coverage, but everything comes at an additional cost. According to a study done in 2007, premiums for plans offering gap coverage are roughly double those of defined standard plans. The 2010 Health Reform bill (Patient Protection and Affordable Care Act) attempted to address the coverage gap by creating discounts on brand name and generic drugs purchased within the gap range. By 2020, the changes in the health care reform act aim to close this coverage gap bringing down the enrollee responsibility to 25% of the costs rather than the current 50%.
Source: bradeninsurance.com

Avoiding the (Medicare) “Doughnut Hole”

According to the new study, and sheer intuition, patients that fall within the doughnut hole are associated with a significant drop in medication use – 12% on average. That is always relevant, but perhaps especially so in the case of depression medication. While discontinuing any prescribed medication is never advisable, it is often easier to justify foregoing depression medication than other medications.
Source: tesarlaw.com

Seniors in Medicare Doughnut hole Skipping Depression Medication

A new study, reviewed in Medpage Today, finds that seniors falling into the Medicare Part D prescription drug coverage gap, often referred to as the “doughnut hole,” reduced the number of monthly anti-depressant prescriptions they filled by 12.1% compared to those with full coverage. In 2012, Part D plans share drug costs with enrollees up to $2,930. With co-pays, premiums, and deductibles seniors pay about $1,500 up to that point. After $2,930 the doughnut hole begins and plan enrollees pay out-of-pocket until they have spent $4,700 – after which the plans pay for 95% of drug costs.
Source: pharmacycheckerblog.com

2011 Income, Poverty and Health Insurance Coverage in the United States Report

Posted by:  :  Category: Medicare

Health Insurance Does Not Insure Health by SavaTheAggieThis report also provides information on household income and its distribution. Americans are continuing to recover from the economic crisis, and while average (inflation-adjusted) household income rose last year, median household income fell by 1.5 percent. It is clear that more work remains to rebuild economic security for our middle class, but it is important to note several factors that contributed to the decline in median income. First, inflation increased 3.1 percent in 2011, more than erasing the 1.6 percent increase in nominal median household income. Inflation in 2011 was boosted significantly by spikes in energy prices. Also, median household incomes have been, and will continue to be, pulled down as the baby boom ages into the retirement years. Household incomes among those over 65, most of whom are retired, are 41 percent less than income among those aged 54-64. So as the number of citizens reaching age 65 increases, median household income will, correspondingly, decrease.
Source: commerce.gov

Video: Newborn with Birth Defect Denied Health Care Coverage Because of ‘Pre-existing Condition’

How the ACA Changes Pathways to Insurance Coverage for People with HIV

There are multiple sources of insurance coverage and care for people with HIV in the United States.  These include public programs, such as Medicaid and Medicare, and the Ryan White HIV/AIDS program, as well as private coverage through an employer or in the individual market. Medicaid, the nation’s principal safety-net health insurance program for low-income Americans, is estimated to cover the largest share of people with HIV. Fewer are covered by Medicare, the federal health insurance program for people age 65 and older and younger adults with permanent disabilities, or have private insurance, and a significant share is uninsured, relying primarily on Ryan White, the nation’s single largest federal grant program designed specifically for people with HIV who are uninsured or underinsured, and operating as the “payer of last resort.” Eligibility for these different coverage sources depends on numerous factors, including state of residence, income, employment and health status, age, and citizenship. As a result, the current system of coverage for people with HIV is a complex patchwork that leaves some outside the system and presents others with barriers to needed access. The Affordable Care Act (ACA), passed in 2010, will expand insurance coverage, and therefore access to care, for millions of people in the U.S., including people with HIV. Some of the ACA’s provisions went into effect soon after the law was passed; most that affect coverage will go into effect in 2014. Access to care, particularly antiretroviral treatment (ART), is not only critical for the health of people with HIV, it also carries important public health benefits with recent research demonstrating that ART significantly reduces the risk of HIV transmission from an HIV positive to negative individual. A new series of infographics developed by Kaiser depicts the pathways to insurance coverage for people with HIV, prior to the ACA, after the ACA was enacted but before 2014, and as of 2014 and beyond. As they indicate, coverage options have already expanded for people with HIV and are expected to expand further in 2014, although coverage will continue to vary across the country. Prior to the ACA (before 2010) Employer-sponsored coverage (ESI) is the primary way in which most people in the U.S. obtain health insurance coverage, although studies indicate that this is less so for people with HIV. Those without access to ESI could attempt to purchase coverage in the individual, non-group market. However, prior to the passage of the ACA, many people with HIV were effectively shut out of the individual market either because HIV was considered an uninsurable, pre-existing, condition by insurers or, if available, was often unaffordable. Medicaid, Medicare, and other public programs, therefore, were important pathways for people with HIV. To be eligible for Medicaid, an individual has to meet the income criteria in their state and belong to a group that was “categorically eligible” (children, parents with dependent children, pregnant women, and individuals with disabilities), and most people with HIV qualify on the basis of being both low-income and disabled. Prior to the ACA, federal law categorically excluded non-disabled adults without dependent children from Medicaid, unless a state obtained a waiver or used state-only dollars to cover them. This presented a barrier, and a “Catch-22,” to many low-income people with HIV who could not qualify for the program until they were disabled, despite the fact that Medicaid covers medications that stave off HIV-related disability and reduce mortality. To be eligible for Medicare, an individual has to be age 65 or older or, if under 65, permanently disabled. If not eligible for Medicare or Medicaid, a person with HIV might have access to state-funded coverage, such as a high risk pool, available in some states, but ultimately, would likely need to rely on the Ryan White program. In addition, Ryan White often “wrapped around” other forms of coverage, including Medicaid and Medicare, providing supplemental services where needed. >>View full-size version (.pdf) ACA Transition Period (2010-2014) The ACA provided additional coverage options in 2010. In the private insurance market, the ACA established a temporary program in every state to allow people with pre-existing medical conditions, such as HIV, who had been uninsured for six months or more and denied insurance coverage to purchase coverage through a Pre-Existing Condition Insurance Plan (PCIP). It also prohibited individual and group health plans from placing lifetime limits on coverage, thereby preventing people with very expensive illnesses from running out of coverage, and extended dependent coverage for adult children up to age 26 in all individual and group plans. In addition, the ACA created a new state Medicaid option for states to cover childless adults with incomes up to 138% of the federal poverty level (FPL) in their Medicaid programs, which several states have already used. Still, even with these expanded options, people with HIV who remain ineligible for coverage, or face limits in their coverage (e.g., benefit limitations), continue to rely on Ryan White. >>View full-size version (.pdf) Full Implementation of the ACA (2014 & Beyond) Most of the ACA’s coverage expansions go into effect in 2014. As of 2014, the ACA requires U.S. citizens and legal residents to have qualifying health coverage, and provides additional insurance market protections, cost-sharing, and coverage options to facilitate coverage. Health insurers will no longer be able to deny coverage to people with pre-existing health conditions (and the temporary PCIPs will no longer be needed). They will also be prohibited from placing annual limits on coverage and be required to guarantee issue and renew health insurance regardless of health status. Individuals will be able to purchase coverage through state-based “Health Insurance Exchanges” and depending on income, people without access to affordable ESI will be eligible for premium and cost-sharing subsidies to purchase coverage in the exchange. Finally, as of 2014, the ACA establishes a new Medicaid eligibility category for citizens and legal residents with incomes up to 138% FPL (thereby removing the categorical eligibility requirement and basing Medicaid eligibility solely on income) and provides states with an enhanced federal matching rate for this population. While a new mandatory eligibility category was established under the law, the Supreme Court of the United States ruled in June 2012 that states could not be penalized if they did not expand coverage to this new group, and it is therefore uncertain if all states will comply with this requirement. >>View full-size version (.pdf) The ACA has already led to improvements in access to and quality of care for people living with HIV and, when fully implemented in 2014, is expected to significantly expand access even further. Still, there are several outstanding questions, including: Will states go forward with the Medicaid expansion and provide coverage to a significant number of people who are HIV positive? Will the benefits package available through Medicaid and the Exchange be sufficient for people with HIV? And, how might the Ryan White program be changed or restructured when it comes up for reauthorization next year, filling in gaps for those who are ineligible for other coverage or still face high cost-sharing for drugs and other health care services? — Jen Kates
Source: kff.org

New Census Data Show Insurance Coverage Expands In 20 States

Politico Pro: Census Details Youth, Insurance Trends Young adults in Vermont saw the biggest increase in private health insurance coverage from 2009 to 2011 — 10.5 percent — while 13 states saw no gains at all, according to a Census Bureau report released Thursday. Drawing on the bureau’s 2011 American Community Survey — an annual demographic assessment of the United States — the report takes a state-by-state look at the change in the insurance rate among adults aged 19 to 25 since the Affordable Care Act mandated that they could remain on their parents’ insurance plans. To gauge the effects of the law, the bureau examined the difference in the rates for 19-to-25-year-olds and 26-to-29-year-olds, two groups that track closely. Private insurance coverage fell by 1.9 percent in the older group but rose 2.7 percent in the younger one (Norman, 9/19).
Source: kaiserhealthnews.org

Report: Extending insurance coverage could reduce longstanding racial disparities in health care

Uninsured people are less likely to receive medical care, the report points out, and a lack of both insurance and access to care for minorities in North Carolina contributes to poorer health outcomes in communities of color, as measured by mortality rates, infant mortality rates, and the prevalence of common and preventable diseases such as diabetes and stroke. African Americans are three times more likely to die from heart disease compared to whites, and on average, minorities with heart failure are younger than whites with the same condition, the report finds.
Source: southernstudies.org

It’s about time! Easier Health Insurance Summaries

Got ideas about how to improve your form? We plan to work closely with the federal agencies in charge of this form to improve it even more over time and we are collecting feedback from real consumers like yourself. After you get YOUR COPY of the form (not the image above), go to www.SBCFeedback.org to tell us what you think. If you enrolled in health insurance coverage this Fall (but not Medicare) and DIDN’T see this form, we want to know that to.
Source: yourhealthsecurity.org

Expanded health care covers more young Marylanders

There was a large difference in the rate of uninsured among Maryland counties in 2011, the data showed. Carroll, Calvert and Anne Arundel counties had the lowest rates of uninsured people as a whole at 4.7, 5.7 and 6.8% respectively. Montgomery, Wicomico and Cecil counties had the highest uninsured rates at 11.7, 11.4 and 10.2 percent.
Source: marylandreporter.com

beSpacific: Income, Poverty and Health Insurance Coverage in the United States: 2011

News release includes links to data: “The U.S. Census Bureau announced today that in 2011, median household income declined, the poverty rate was not statistically different from the previous year and the percentage of people without health insurance coverage decreased. Real median household income in the United States in 2011 was $50,054, a 1.5 percent decline from the 2010 median and the second consecutive annual drop. The nation’s official poverty rate in 2011 was 15.0 percent, with 46.2 million people in poverty. After three consecutive years of increases, neither the poverty rate nor the number of people in poverty were statistically different from the 2010 estimates. The number of people without health insurance coverage declined from 50.0 million in 2010 to 48.6 million in 2011, as did the percentage without coverage – from 16.3 percent in 2010 to 15.7 percent in 2011. These findings are contained in the report Income, Poverty, and Health Insurance Coverage in the United States: 2011.”
Source: bespacific.com

Buy Visitors Insurance Coverage

When anyone is planning to travel to America or any other nation, health and medical care are two areas that are extremely important and cannot be ignored. It is extremely vital for every individual or family visiting USA or traveling outside his or her home country to make sure that they are covered with visitor medical insurance. This is particularly important in the western world like the U.S. where costs of medical care are very high. If someone is traveling for the first time or subsequently, it is prudent to ensure that adequate visitor health insurance is purchased.
Source: visitorshealthinsurance.com

AHIP Testimony: Value Offered by Health Plans Participating in the Medicare Advantage Program

  Medicare Advantage plans also protect beneficiaries from catastrophic health care costs.  In 2012, all Medicare Advantage plans offer an out-of-pocket maximum limit for beneficiary costs, and about 78 percent of Medicare Advantage enrollees are in plans that have annual out-of-pocket maximums of $5,000 or less.  These out-of-pocket maximums – which are not offered by the Medicare FFS program – help protect Medicare beneficiaries from catastrophic health care expenses that otherwise might pose a serious threat to their financial security.  Medicare Advantage plans also help reduce out-of-pocket costs for enrollees by reducing premiums for Part B and Part D, and by limiting cost-sharing for Medicare-covered services, including primary care physician visits and inpatient hospital stays.
Source: ahipcoverage.com

Income, Poverty, and Health InsuranceCoverage in the United States: 2011

If there is a kryptonite to the Superman of asset prices, Ben Bernanke, it is inflation and its direction over the months while the Fed continues to print more money will be the most important thing to watch. Today’s Aug CPI is expected to rise .6% m/o/m, the largest gain since June ’09 led by energy and food prices. The core rate is expected to be up a more benign .2% m/o/m. In the meantime we have crude above $100 today for the 1st time since May, gasoline prices at the pump the most since April and the US$ is…
Source: ritholtz.com

The Sensible Solution for Pre

Comments are subject to approval and moderation. We remind everyone that The Heritage Foundation promotes a civil society where ideas and debate flourish. Please be respectful of each other and the subjects of any criticism. While we may not always agree on policy, we should all agree that being appropriately informed is everyone’s intention visiting this site. Profanity, lewdness, personal attacks, and other forms of incivility will not be tolerated. Please keep your thoughts brief and avoid ALL CAPS. While we respect your first amendment rights, we are obligated to our readers to maintain these standards. Thanks for joining the conversation.
Source: heritage.org

Obama, Ryan will address AARP in New Orleans as Medicare debate rages

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ...More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524The Romney campaign disputes that the proposal is a “voucher” plan, and accuses the president of pilfering $716 billion from the Medicare program to pay for the Affordable Healthcare Act, his signature healthcare reform law. The Obama campaign says the Medicare savings will come from holding down payments to hospitals and insurers, not reducing benefits to retirees.
Source: nola.com

Video: Senator Harkin Addresses False Claims That Health Reform Will Hurt Medicare Recipients

Obama Claims Romney Presidency Would Be ‘Inside Job’

Americans 50 and over — the age that qualifies for AARP membership — are an especially important demographic for the candidates to persuade because they register in greater numbers those who are younger and are almost twice as likely to cast their ballot. An Associated Press-GfK poll that was released this week found Romney was favored by seniors likely to vote, 52 percent to 41 percent for Obama.
Source: cbslocal.com

Baumann v. American Family Mutual Insurance, 2012 U.S. Dist. LEXIS 5247

This interesting case does not take into account the Defendant Insurance Carrier’s Mandatory Insurance Reporting responsibility.  Medicare is a secondary payer if another plan is responsible to make payment for an item or service.  Once a determination of responsibility is made, the Defendant Insurance Carrier is responsible to report its Ongoing Responsibility for Medical (ORM).  When Medicare is aware of the Defendant insurance carrier’s responsibility to pay medicals, it will suspend future Medicare benefits and redirect providers to bill the Defendant insurance carrier.  Medicare will also review its records and determine if it may have made any mistaken payments.  If it has, it will issue to the Defendant Insurance Carrier a Conditional Payment Letter as a start to the reimbursement process.   Thus, even in Defendant insurance carrier were successful in achieving a set-off it would not escape exposure to Medicare as once judgment is entered,  the Mandatory Insurance Reporting responsibility would require it be reported and any Conditional Payments owed Medicare would then have to be reimbursed.  If not, Medicare has the right to file a lawsuit for double damages against the insurance carrier.  Of course, this is all dependent on Medicare being aware of the Defendant insurance carrier’s responsibility to pay medicals and subsequent judgment.  In the past, Medicare had no way of identifying these situations.  However, with the implementation of Mandatory Insurance Reporting and penalties for failure to report these situations, Medicare is now better aware of these situations and will protect itself.  Recoveries are to be expected as well as Medicare denying future Medicare benefits.  State court Judgments that attempt to maintain Medicare as a primary payer, in situations where medical benefits are available to pay, don’t work.  Federal law will supersede and the Defendant insurance carrier should proactively address Medicare rather than pin responsibility on the Medicare beneficiary.    In this case, the legal decision has placed the Defendant Insurance Carrier in a worst position.  It now has to pay the entire funds to Plaintiff, but is still required to report the situation to Medicare that it has a responsibility to pay.  It is subject to a reimbursement claim by Medicare if Plaintiff does not immediately reimburse the conditional payments under 42 C.F.R. Section 411.24(i).  It could now pay twice for the same exposure.  Dealing with Medicare upfront saves money.
Source: thefoodchainblog.com

AARP: Presidential Debates Must Address Social Security, Medicare

AARP is a nonprofit, nonpartisan organization, with a membership of more than 37 million, that helps people 50+ have independence, choice and control in ways that are beneficial to them and society as a whole. AARP does not endorse candidates for public office or make contributions to either political campaigns or candidates. We produce AARP The Magazine, the definitive voice for Americans 50+ and the world’s largest-circulation magazine; AARP Bulletin, the go-to news source for the 50+ audience; AARP VIVA, a bilingual lifestyle multimedia platform addressing the interests and needs of Hispanic Americans; and national television and radio programming including My Generation and Inside E Street. The AARP Foundation is an affiliated charity that provides security, protection, and empowerment to older persons in need with support from thousands of volunteers, donors, and sponsors. AARP has staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Learn more at www.aarp.org.
Source: enewspf.com

AHIP Testimony: Value Offered by Health Plans Participating in the Medicare Advantage Program

  Medicare Advantage plans also protect beneficiaries from catastrophic health care costs.  In 2012, all Medicare Advantage plans offer an out-of-pocket maximum limit for beneficiary costs, and about 78 percent of Medicare Advantage enrollees are in plans that have annual out-of-pocket maximums of $5,000 or less.  These out-of-pocket maximums – which are not offered by the Medicare FFS program – help protect Medicare beneficiaries from catastrophic health care expenses that otherwise might pose a serious threat to their financial security.  Medicare Advantage plans also help reduce out-of-pocket costs for enrollees by reducing premiums for Part B and Part D, and by limiting cost-sharing for Medicare-covered services, including primary care physician visits and inpatient hospital stays.
Source: ahipcoverage.com

Obama Slams Romney’s Medicare Plan to AARP

(WASHINGTON) — Appealing to senior voters, President Obama today defended his Medicare and social security policies, while claiming his opponents would slash the popular entitlement programs to give tax breaks to the wealthiest Americans. “There’s a lot of talk about Medicare and Social Security that hasn’t been completely on the level over the last several months,” the president told an AARP convention via satellite. “Here is what you need to know: I have strengthened Medicare as president.” “These are bedrock commitments that America makes to its seniors, and I consider those commitments unshakeable,” he continued. The president took a swipe at rival Mitt Romney’s claim that the 47 percent of the electorate that will vote for Obama are people who are “dependent upon government” and believe “that they are victims.” “Medicare and Social Security are not handouts. You’ve paid into these programs your whole lives,” the president said to applause. “You’ve earned them and as president it’s my job to make sure Medicare and Social Security remain strong for today’s seniors and future generations.” Obama argued that his signature legislative achievement – “Obamacare” –  has extended the financial solvency of Medicare and lowered costs for millions of American seniors. Invoking a new administration study of the law, Obama claimed the average Medicare recipient will save $5,000 over the next 10 years thanks to provisions in the Affordable Care Act.  He said the measure to close the so-called prescription drug donut hole has saved 5.5 million seniors an average $641 each this year alone. The Obama campaign has been attacking Romney and his running mate Paul Ryan on the airwaves in key battleground states, including a new TV ad launching today that says the Republicans’ proposed “premium support” plan for Medicare — a voucher-style system — will heap costs on seniors to the tune of $6400 per year. “We do have to reform and strengthen Medicare for the long haul, but we’re going to do it by reducing the costs of care — not by asking seniors to pay thousands of dollars more while we’re giving millionaires and billionaires a massive new tax cut,” Obama said. “The other side’s approach to saving Medicare — and you’ll be hearing about this, I gather, after I speak — is to turn Medicare into a voucher program and essentially transfer those costs onto seniors,” Obama explained. “All seniors at some point end up being at the mercy of the insurance companies.” Ryan, who is addressing AARP in person today, was preparing to argue that Obama has already altered the program and has failed to address its financial woes for the long-term. “Our plan keeps the protections that have made Medicare a guaranteed promise for seniors throughout the years. It makes no changes for those in or near retirement,” Ryan will say, according to his prepared remarks. “Our plan empowers future seniors to choose the coverage that works best for them from a list of plans that are required to offer at least the same level of benefits as traditional Medicare.  This financial support system is designed to guarantee that seniors can always afford Medicare coverage –- no exceptions.  And if a senior wants to choose the traditional Medicare plan, then she will have that right. Ryan blames Obamacare with weakening the program’s finances by reducing Medicare payments to health care providers and cutting waste, fraud and abuse by $716 billion over 10 years. Copyright 2012 ABC News Radio
Source: abcnewsradioonline.com

Georgia Cancer Specialists Settles with Feds over Medicare Billing

The civil settlement resolves the United States’ investigation into Georgia Cancer Specialists’ practices relating to billing for evaluation and management (E&M) services on the same day as a related procedure. Generally, providers are not permitted to bill both E&M services and a related procedure on the same day under the Medicare program’s regulations. 
Source: patch.com

Senate Special Aging Cmte. Looks at Medicare Fraud

The nation’s largest employers expect health care costs to rise with the implementation of the Affordable Care Act. That’s according to a survey by the National Business Group on Health released Monday with a first look at the effects of the new health care law on large businesses. The survey outlined costs, health care plan changes for 2013 and adjustments businesses are making to ensure their benefit plans comply with the health care law. National Business Group on Health President and CEO Helen Darling announced the survey’s findings, 
Source: c-span.org

Ohio Medicaid Program Raises Stakes For Nursing Homes

Posted by:  :  Category: Medicare

Attorney General Richard Cordray Announces Candidacy for Re-election by ProgressOhioStates such as Colorado, Georgia, Kansas, Nevada, Oklahoma, Utah and Vermont have tried to change that by awarding a small bonus (from 60 cents to $6.16 per day) if facilities achieve various standards.  But industry representatives say those incentives are insufficient to generate significant enthusiasm for altering the status quo, according to Nicholas Castle, who has surveyed nursing home administrators and is a professor of health policy at the University of Pittsburgh.
Source: kaiserhealthnews.org

Video: What Are The Ohio Medicaid Eligibility Guidelines

Ohio should say yes to Medicaid expansion

5) Ohio can’t afford not to expand. If Ohio does not implement the expansion, federal funds that help pay for care for people without insurance will decline here, but costs for treating those people will not. Federal funds that help states pay for care for people without insurance are set to drop starting in 2014. That’s because the health reform law anticipates that as states expand Medicaid, there will be fewer people without insurance needing emergency room care. But in states that do not expand Medicaid the treadmill of treating the poorest and sickest in emergency rooms will continue. If that’s the case in Ohio, hospitals would face unattractive options: reducing services, shutting down, raising treatment fees on people with insurance, or seeking state tax dollars.[17] 
Source: policymattersohio.org

Court settles dispute over Ohio Medicaid contract

Recently it was reported that Aetna Better Health of Ohio sued the Ohio Department of Job and Family Services over the way in which it scored the Medicaid contract applications. Keep in mind that Medicaid is a federal program that is administered by the state. At issue is the fact that Aetna was originally awarded one of the Medicaid contracts, and then the state rescinded the decision.
Source: cnwlaw.com

Ohio Medicaid made Cabinet

The current economic contractions have caused 20% of the Ohio population to become Medicaid recipients. Governor Kasich has started to transfer the Medicaid program from the Department of Jobs and Family Services to create a separate Ohio Department of Medicaid.
Source: soundentistry.com

Ohio: Ohio Medicaid Drug List

There are no longer any Ohio Schools through alternative routes. As the ohio medicaid drug list, Ohio debt consolidation loans are being implemented. These regulations that are generally supported by the ohio medicaid drug list of Agriculture they would find every county fair in Ohio. Ohio has an excellent idea. In Ohio, laws concerning domestic pets are very reasonable regardless of where each of them. Some of the ohio medicaid drug list of loans outside the ohio medicaid drug list over four million dollars towards expanding the ohio medicaid drug list in the region.
Source: blogspot.com

Managing Medicaid: editorial

The Office of Health Transformation, which Kasich created to coordinate with all state health-related programs, already has made significant improvements in streamlining government health-care programs. It has changed contracts with managed-care providers to build in incentives for keeping costs down and patients healthier, by encouraging better preventive and follow-up care, and has asked the federal government for permission to extend those managed-care principles to the neediest patients — those eligible for both Medicaid and Medicare, the health-insurance program for the elderly.
Source: delphoschamber.com

Ohio hospitals back Medicaid expansion

Kasich and members of his administration have said a decision has not been made about whether to expand coverage. Ohio and Kentucky are among dozens of states that have yet to commit to expand the program, which would cost state taxpayers hundreds of millions of dollars but bring in billions more in federal money during the next decade, according to the Washington, D.C.-based Urban Institute, a nonprofit, nonpartisan policy research organization.
Source: cincinnati.com

Visit Buttacavoli at Health Fairs in Stark County Medicaid Information

As we get older, it’s important to learn as much as we can about specific government programs that focus on the needs of senior citizens. If you or a loved one requires clarification on the rules and regulations of such programs, it is in your best interest to speak to an elder law attorney who works to protect the rights of seniors. Fortunately for you, Glen F. Buttacavoli is one professional in the Stark County, Ohio area who is dedicated to providing information on Medicare and Medicaid to locals in need. By visiting the Faith in Action Senior Health Fair in Massillon, Ohio or the 2012 Senior Citizen Forum in Canton, Ohio, you will have the opportunity to hear Buttacavoli speak about the importance of these issues.
Source: ishopblogz.com

Ohio Medicaid eyeing Aetna, UnitedHealthcare

The following managed care organizations were selected in each of the three regions: Aetna Better Health of Ohio, CareSource, Meridian Health Plan, Paramount Advantage and United Healthcare Community Plan of Ohio.
Source: publicus.com

Paul Ryan Called for Ending Social Security in Speech to Ayn Rand Fans

Posted by:  :  Category: Medicare

Social Security Adminstration building on Edsall Rd - 100-0027 by Rev. Xanatos Satanicos Bombasticos (ClintJCL)How different is that, then, from Mitt Romney’s notion that the 47 percent of the American public who pay no income tax (in most cases because they are low-income in an economy that was ravaged by Republicans), or who partake of government programs, will “vote for the president no matter what”? David Koch’s Youthful Ward Ryan’s speech to the Atlas Society was delivered just as Americans For Prosperity, the organization founded and funded by billionaire brothers Charles and David Koch, began organizing on the ground in Wisconsin. Ryan, already in Congress, saw the opportunity to ally with like-minded moguls who were building a get-out-the-vote and organizing infrastructure that was likely to benefit him. As AlterNet reported, Ryan was the recipient of an award from the Wisconsin chapter of Americans For Prosperity in 2008 — an award presented him by a young county executive named Scott Walker, who is now the governor of Wisconsin. Ryan is also among the few elected officials ever invited to Charles Koch’s secret summits for wealthy donors. As the New York Times’ Nicholas Confessore reported in August, Americans For Prosperity embraced Ryan, now 42, practically from the moment of its founding:  
Source: alternet.org

Video: US Social Security (Politics in Ecolang.)

The Federal Reserve Is Systematically Destroying Social Security And The Retirement Plans Of Millions Of Americans

Last week the mainstream media hailed QE3 as the “quick fix” that the U.S. economy desperately needs, but the truth is that the policies that the Federal Reserve is pursuing are going to be absolutely devastating for our senior citizens.  By keeping interest rates at exceptionally low levels, the Federal Reserve is absolutely crushing savers and is systematically destroying Social Security.  Meanwhile, the inflation that QE3 will cause is going to be absolutely crippling for the millions upon millions of retired Americans that are on a fixed income.  Sadly, most elderly Americans have no idea what the Federal Reserve is doing to their financial futures.  Most Americans that are approaching retirement age have not adequately saved for retirement, and the Social Security system that they are depending on is going to completely and totally collapse in the coming years.  Right now, approximately 56 million Americans are collecting Social Security benefits.  By 2035, that number is projected to grow to a whopping 91 million.  By law, the Social Security trust fund must be invested in U.S. government securities.  But thanks to the low interest rate policies of the Federal Reserve, the average interest rate on those securities just keeps dropping and dropping.  The trustees of the Social Security system had projected that the Social Security trust fund would be completely gone by 2033, but because of the Fed policy of keeping interest rates exceptionally low for the foreseeable future it is now being projected by some analysts that Social Security will be bankrupt by 2023.  Overall, the Social Security system is facing a 134 trillion dollar shortfall over the next 75 years.  Yes, you read that correctly.  The collapse of Social Security is inevitable, and the foolish policies of the Federal Reserve are going to make that collapse happen much more rapidly.
Source: theeconomiccollapseblog.com

Obama Tells Seniors They've 'Earned' Medicare and Social Security, Forgets to Note We Haven't Paid For Them

Social Security, meanwhile, certainly isn’t a guarantee. Obama might consider the retirement program a “bedrock commitment,” but the Supreme Court doesn’t. The court has ruled on two difference occasions that citizens are not entitled to the dollars they pay into the entitlement. Money paid into the program can be used to fund other totally unrelated government activities, just like any other tax dollars. The commitment to the program is dependent on the whim of politicians who are legally allowed to tax you for one thing and use that same money to pay for something else. That — and nothing else — is what seniors paying into Social Security have actually earned. 
Source: reason.com

Social Security: Corporate Retirement Funding

Stephanie Zvan is an analyst by trade, but she’s paid not to talk about it. She also writes science fiction and fantasy, so she knows firsthand that the impact of a story is usually unrelated to its truth. As though that weren’t enough to keep her busy, Stephanie is also one of the hosts for Atheists Talk, a radio show and podcast produced by the Minnesota Atheists. She speaks on science and skepticism in a number of venues, including science fiction and fantasy conventions. Stephanie has been called a science blogger and a sex blogger, but if it means she has to choose just one thing to be or blog about, she’s decided she’s never going to grow up. In addition to science and sex and the science of sex, you’ll find quite a bit of politics here, some economics, a regular short fiction feature, and the occasional bit of concentrated weird. Oh, and arguments. She sometimes indulges in those as well. But I’m sure everything will be just fine. Nothing to worry about. Nothing at all.
Source: freethoughtblogs.com

ACLU must want Social Security and Medicare shut down, too.

The right wants to jeer him. The left wants to censor him. Moderates usually want both. Brian Kirwin is a political consultant and public relations strategist in Virginia Beach with a lightning-rod flair. Brian also serves on the VB Arts & Humanities Commission and frequently appears on Hampton Roads theatrical stages, if only to prove that all actors aren’t liberals. Kirwin’s columns stir up debate and hit the political scene with no punches pulled.
Source: bearingdrift.com

Daily Kos: Paul Ryan targeted Social Security and Medicare as ‘collectivist’ barriers to dog

grytpype, ferg, glitterscale, daninoah, mimi, OLinda, celdd, eeff, etatauri, eyeswideopen, nicki37, 88kathy, whenwego, KevinNYC, Frederick Clarkson, navajo, antirove, menodoc, hopesprings, Eyesbright, Spot Cat, kj in missouri, HeyMikey, Steveningen, Timbuk3, Curt Matlock, valadon, Gowrie Gal, Brecht, vcmvo2, marina, 3goldens, PSzymeczek, SaraBeth, Gordon20024, Phil S 33, SBandini, irishwitch, detroitmechworks, Russgirl, luckydog, Lefty Coaster, gpoutney, Clive all hat no horse Rodeo, kurt, Little, marykk, Dartagnan, puakev, Mary Mike, HCKAD, millwood, billso, TomP, OleHippieChick, Sixty Something, skohayes, jakebob, beltane, dewley notid, briefer, maggiejean, bluemoonfever, arendt, litoralis, LinSea, CanyonWren, maryabein, Remediator, orangeuglad, Larsstephens, Railfan, smileycreek, CajunBoyLgb, FogCityJohn, eXtina, estreya, gramofsam1, Polly Syllabic, Eddie L, Publius2008, slice, no way lack of brain, spooks51, vahana, Mr MadAsHell, anyname, NormAl1792, Jasonhouse, Marihilda, Desert Scientist, jolux, DRo, googie, Auriandra, ParkRanger, Williston Barrett, Siri, We Won, Eric Nelson, a2nite, JGibson, Lorinda Pike, This old man, doroma, Glen The Plumber, George3, koosah, vlyons, Icicle68, Floyd Blue
Source: dailykos.com

Living on Social Security alone

Will that happen? I wouldn’t hold my breath. In the meantime, the best retirement planning starts with taking the initiative to open a retirement savings account and putting as much as you can into it. Munnell says the typical household approaching retirement (ages 55 to 64) has only $120,000 in 401(k)/IRA balances. Assuming that the household purchases a joint-and-survivor annuity at retirement, its monthly income from savings would amount to only $575, she calculates.
Source: bankrate.com

Medicare Battle Heats Up California House Race

Posted by:  :  Category: Medicare

Grand Bargain Watch - Save Social Security by DonkeyHoteyBera was a newcomer to politics in 2010 when he ran a surprisingly strong campaign against Lungren, losing by 7 percentage points in a year in which Republicans made record gains in the House. But in this year’s rematch, Bera is placing greater emphasis on his medical background: he served as chief medical officer for a large California hospital chain and later in the Sacramento County public health department, tasked with providing medical care for some 225,000 uninsured people.
Source: kaiserhealthnews.org

Video: Medicare Supplement Plans | Compare Medicare supplement Health Plans

Romney’s proposal for Medicare would benefit insurance companies, raise costs for seniors

As part of the Affordable Care Act, $716 billion was cut from Medicare spending (not funding). A big chunk of this cut was reducing spending on the Medicare Advantage program, a failed privatization plan. Medicare Advantage turned over a part of Medicare to private health insurance companies. But instead of costing less, it has always cost more than the government Medicare program to provide the same benefits. This is a no-brainer since the private, for-profit insurance companies have to pay dividends and huge executive salaries that Medicare does not. This is why 98% of Medicare spending goes to health care, while private insurance companies have spent only 80% or even less, with the rest going to shareholders, executives and waste. The Affordable Care Act tries to reign in this spending.
Source: fightbacknews.org

Medical Insurance for an American Expat in Thailand

As an Expat, you are still going to be faced with the prospect of sometimes needing medical care.  If we were all so wealthy that we didn’t have to think about the expense, it would be perfect, but 99% of us still ponder how we are going to handle things if (when?) we get deathly ill with some cancer or fall off the back of a motorcycle and need immediate expensive care.  A reasonable person will have these thoughts in the back of their mind always, and we all know it is better to do something to prevent problems before we actually must have help.  So medical insurance is important, and every Expat had better give a lot of thought to it while they are still walking around and healthy.
Source: americanexpatchiangmai.com

HHS Touts Growth In Medicare Advantage Plans, Drop In Premiums

More than 13 million Medicare beneficiaries – just over a quarter of all Medicare enrollees – are in Medicare Advantage plans, an alternative to traditional Medicare offered by insurance companies. The health law will reduce payments to Medicare Advantage plans by $156 billion from 2013 through 2022, according to the Congressional Budget Office. President Barack Obama and many Democrats have backed payment cuts to the plans, citing data that the government has in the past paid about 14 percent more per beneficiary in Medicare Advantage than per beneficiary enrolled in the traditional program. Proponents of the private plans point to their better coordination of care and extra benefits and services they provide, including vision, hearing and dental benefits.
Source: kaiserhealthnews.org

ONLY ON 3 UPDATE: Injured man on Medicare is able to stay in hospital to await surgery

Tom, I know portions have kicked in, like the part that removed the lifetime cap on benefits. This alone saved us from financial ruin when my wife came down with cancer. I am sure more provisions will be forthcoming. What gets me is all these people have moaned and groaned for years about having to foot the medical bills for those who choose not to carry insurance. Obama did something about it and they are still whining. Probably most of those who are complaining the most are the ones that will have to slack off on their Marlboros, cheap beer, tattoos and piercings and use that money to buy insurance.
Source: wwaytv3.com

Grappling With Details of Medicare Proposals

Still, it’s clear the proposed changes would shift costs from the federal government to retirees. An early version of a Republican plan would have more than doubled out-of-pocket health expenses for older adults, to $12,500 in 2022, the Congressional Budget Office estimated. “All scenarios will require seniors to pay more,” said Robert Moffit, senior fellow at the Heritage Foundation, a conservative research organization in Washington. To think otherwise, he said, “is a fantasy.”
Source: nytimes.com

Obamacare a boon after all

What does Obamacare do?  It already is starting to close the famed doughnut hole in the senior drug plan.  It is providing preventive healthcare services with little or no co-pay, including contraception and well-being visits for women.  There is no lifetime cap on how much you can be reimbursed for expenses, as so many insurance company plans had.  It allows children up to 26 to stay on their parents’ medical plan.  The Centers for Disease Control and Prevention just reported a sizable drop in the number of young who don’t have insurance as a result. That’s fast work.
Source: triplecrisis.com

Brad DeLong: The Policy Substance Underlying Today’s Politics

Hey seniors! The Republican platform calls for turning Medicare into a voucher program and for eliminating important benefits for you–they want to reopen the Medicare drug “donut hole”. They would want to raise your Medicare premium by an average of $577/yr a decade from now. Why? Because they seem hell-bent on restoring $716 billion in wasteful Medicare payments to insurance companies and over-treating specialists. We don’t know the full details. They won’t tell us. Republicans’ rhetoric and plans keep shifting as the American people responds with dismay to what Republicans propose. It won’t be good. We do know that two-thirds of Medicaid dollars are used to care for the elderly and the disabled, and that the Republicans have pledged to cut Medicaid dramatically.
Source: typepad.com

Eldercare Resource Center: Medicaid’s Assisted Living Benefits: A Good Option for the Lucky Few

Posted by:  :  Category: Medicare

"Citizenship is a tough occupation which obliges the citizen to make his own informed opinion and stand by it." ~ Martha Gellhorn  by eyewashdesign: A. GoldenQuestions about Medicaid’s assisted living benefits are probably the second most common questions we receive. The first being the more rhetorical “what do you mean Medicare doesn’t pay for assisted living?”. The latter has a simple answer, but the former is much more complicated as Medicaid benefits vary from state to state. Our organization recently undertook a major research project to determine just what Medicaid will pay for with regards to assisted living in the year 2012. The first and most important point to make is that institutional or long term care Medicaid does not pay for assisted living. It is intended to help improvised individuals who require nursing home care. However, Medicaid Waivers in many states do provide assistance to individuals in assisted living residences. To avoid future confusion, we should mention that Medicaid Waivers are often referred to HCBS, Home and Community Based Services,1915 Waivers and sometimes Demonstration Projects. The second, and also critically important point to make, is that unlike institutional Medicaid, Waivers are not entitlements. An entitlement program means that if one meets the eligibility requirements, they receive the benefits. Waivers, on the other hand, have enrollment caps (or slots in Medicaid parlance). Each Waiver is approved to assist a limited number of persons and once the limit has been reached, a waiting list is started. Another finding from our study was that the types of assisted living benefits varied by state and can be loosely grouped into one of three categories. 1) Personal Care Only – these states will pay for their waiver participants personal care costs regardless of the location in which they reside. Therefore, assisted living residents could expect the personal care portion of their assisted living bills to be covered, at least up to Medicaid’s allowable reimbursement rates. 2) Nursing Home Level Care – similar to above, these states pay for personal care but also cover other nursing home level types of care for waiver participants. Again, independent of residence. 3) Complete Assisted Living – in these states, their Medicaid Waivers will pay for both personal care, nursing home level care and the room and board costs for the participants. Individuals must reside in assisted living communities which accept Medicaid reimbursements. While the number of individuals receiving Medicaid help in assisted living is limited as is the amount of assistance they receive; the situation is not all doom and gloom. In fact, the long term view (current political environment aside) can almost be considered rosy. Ten years ago, approximately half the number of states provided assistance and we fully expect this positive trend will continue. Ten years from now, Medicaid Waivers in all 50 states will likely be covering assisted living for the elderly in some capacity. We’ve consolidated the results from our study into a State by State Guide to Medicaid’s Assisted Living Benefits in which we explore each state’s coverage, its limitations and other state based alternatives.
Source: blogspot.com

Video: Medicare Provider, Assisted Living

Does Your State Accept Medicaid For Assisted Living Facilities?

As of publication, there are no definitive lists that outline states with Medicaid waiver programs for assisted living facilities. At best, the government (via the Centers of Medicare and Medicaid Services) has created an online list of all Medicaid waiver programs (1), meaning visitors have to spend time finding the desired information. Although I’ve outlined the states that do accept Medicaid waiver programs, unavoidable impediments may be in place to securing a Medicaid-covered bed in an assisted living facility. Be aware that some states may offer the agenda on a trial basis, supervene wee participation quotas, or are just introducing the agenda to state residents. As always, verify eligibility requirements with the Centers for Medicare and Medicaid Services.
Source: blogspot.com

2012 Long Term Care Information Sheet

Are government benefits available to assist in paying for long term care costs?: The Medicaid program, founded in 1965 concurrently with Medicare, is the primary government program that helps with the cost of long term care. Unlike Medicare, which is funded and directed solely by the federal government, Medicaid is a joint enterprise between the state and federal governments. There are many different programs of assistance within the Medicaid system. The nursing home program is called “Institutional Care Program”, or “ICP”. Persons eligible for ICP receive financial assistance for the costs associated with residing in skilled nursing facilities (nursing homes). Medicaid generally does not pay for assisted living; although a limited Medicaid waiver program and a “diversion” program may provide relief for some eligible residents. The cost of living at an assisted living facility must usually be privately paid.
Source: boyerjackson.com

Dangers of Assuming Medicare Covers Everything

Elderly home care is and will continue to be much more cost effective now and in the future. When considering the cost of elder home care versus assisted living costs, there are many factors to take into consideration. One consideration is to understand the trends of the health care industry, so that you can financially plan for your future. Many believe that Medicare will cover everything they need as they age. Although many realize that they need to financially prepare for the future, most do not investigate the cost and options of future care needs. Many do not feel that they can afford to invest in long term care insurance.
Source: futonello.info

Fla. Assisted Living Facility Owner Sent to Prison for $1.1 Million Medicare Fraud Scheme

The kickback scheme involved funneling patients to a fraudulent mental health provider, American Therapeutic Corporation, in exchange for illegal healthcare kickbacks. Denica, the owner of Robyll Care Assisted Living Facility, admitted she knew ATC falsely billed Medicare for partial hospitalization programs (PHP)—a form of intensive treatment for severe mental illness—based on her fraudulent referrals, court documents say. 
Source: seniorhousingnews.com

Opening the door to assisted living

Purtell says assisted living centers have been offering some of the medical services often found in nursing homes such as treating residents with dementia. He also says Medicare waiver programs offering assisted living is another reason for the uptick in these facilities “whereas 15 years ago, particularly on the Medicaid side, it was nursing homes or nothing.”
Source: wrn.com

[WATCH]: Medicare Provider, Assisted Living

www.hospicecarehome.com www.hospicecarehome.com Free video, video sharing, watchvideo of hospice care, hospice services, palliative care, medicaid, hospice palliative care, hospice and palliative care, medicare, end of life care Video, News video of Hospice Care, Hospice Services, Palliative Care, Medicaid Web Directory Ipod video, free download video of Hospice palliative care, hospice and palliative care, medicare, end of life care online guide. www.hospicecarehome.com Comprehensive
Source: wordpress.com

Medicare Assisted Living Benefits

Assisted Living is not covered by Medicare. Medicare, along with a Medicare Advantage plan or a Medicare Supplement, will partially pay for short term (100 days) skilled nursing at a facility (with restrictions). Medicaid will pay for assisted living but you need to qualify by having low income and little assets. If you have too much in assets you will be required to dispose of those assets (within limits) and pay what you can toward the assisted living. If you have too much income you will have to use all income (within limits) to pay then Medicaid will pay the balance.
Source: comforcare.com

nursing homes in buffalo ny, assisted living facilities cincinnati, nursing jobs cincinnati

There are twelve standardized Medigap plans, A through L. In most states, you can go to any physician or hospital that accepts Medicare without pre-authorization. Under plans C through J, days one through twenty are wholly paid for by Medicare. For days twenty one through one hundred, the Medicare co-pay for 2010 is 7.00 which is covered by the Medigap policy. From day one hundred one and beyond, the outpatient is responsible for the full cost.
Source: blogspot.com

Changes Coming for Medicare Set

Posted by:  :  Category: Medicare

OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSCurrently, parties in workers’ compensation cases may utilize a Medicare review process to determine how much money must be put into a MSA for future medical expenses.  But no such option exists for liability settlements because MSAs in liability settlements are much more complicated.  Settlements in liability cases usually resolve all claims in the case, which could include property damages, past and future medical expenses, pain and suffering, etc.  Consequently, it is often impossible to determine how much of a settlement the parties intended to compensate for future medical expenses.  Obviously, most plaintiffs who are covered by Medicare prefer to have as little of the settlement funds allocated to future expenses as possible.  But defense lawyers and their clients have to protect themselves against any future claims from Medicare if plaintiffs misappropriate settlement funds that they should have used for future medical expenses.  
Source: dbllaw.com

Video: Structured Medicare Set Aside

How Workers Compensation is Affected by Medicare Set Asides

The Mandell Law Firm, in Northridge, is an aggressive personal injury and wrongful death law firm serving clients throughout the San Fernando Valley, the Greater Los Angeles area, and Southern California. If you or a family member is involved in a workers compensation settlement that might include a Medicare Set Aside, Mara Burnett can help. Experienced and reputable, Mara and the other attorneys at Mandell Law provide hands-on care and a sincere commitment to victims of accidents. Contact Mara Burnett for a free consultation at 818.866.6600.
Source: mandellaw.com

National Alliance of Medicare Set

It is a federal statute establishing that Medicare is the payer of last resort when a Medicare recipient is injured. Medicare’s responsibility to pay for the medical bills arising out of the injury is secondary to the party responsible for the injury. When the injured plaintiff recovers an award from a lawsuit or settlement, Medicare must be reimbursed for the portion that was for past medical expenses and set aside the portion for expected future medical expenses.
Source: oasislawfirm.com

California: Can an Attorney Fee Be Requested on a Medicare Set

“The WCJ gave undue weight to the panel decision in Pratt, supra. We reiterate that, notwithstanding the fact that someone at LEXIS deemed the Pratt decision “noteworthy,” prior panel decisions are not binding on WCJ’s or subsequent Appeals Board panels. In Pratt, an Appeals Board panel concluded that, in that case, sums used to fund a Medicare Set Aside account should not be utilized in calculating a reasonable fee… We reject any argument that the Pratt panel was attempting to lay down an all-encompassing rule stating that it is improper to base an attorney’s fee on a Medicare Set Aside when there has been a prior award of medical treatment, or that we would be bound by such a holding. Although disregard of the Medicare Set Aside funds may be appropriate in setting a reasonable attorney’s fee in the proper case, given the results obtained, disregard of those funds would not be reasonable in the instant case.”
Source: lexisnexis.com

Is Medicare as we know it going away? Liability Medicare Set Aside Rules

In addition, there is apparently no fundamental recognition by CMS of the differences between the realities of liability settlements and workers’ compensation settlements based upon the ANPRM options. Where MSAs have been commonplace in workers’ compensation settlements, there is always an allocation of the damages recovered between future medical and indemnity. Workers’ compensation is a no-fault system and the carrier is obligated to pay for all future medical expenses unless there is a medical washout. That isn’t the case for liability settlements. Instead, settlements are done on an unallocated basis and factors such as comparative fault, causation issues, liability issues, caps on damages, policy limits and other factors cause cases to be resolved for far from full value. Any system that does not account for these differences when it comes to future medicals that are Medicare covered can’t work. A blanket rule regarding future medicals that does not provide safe harbors or consideration of the realities of liability settlements could discourage settlements and prevent lawyers from taking cases at all if they involve a Medicare beneficiary. This could cause Medicare to not recover conditional payments and be on the hook for all future medical if there is no recovery.
Source: vancouverwashingtonaccidentinjuryattorney.com

Federal Judge finds that a Medicare Set Aside is not required in a liability settlement

While CMS plows forward to codify how to best protect its future exposure in liability settlement, On July 24, the U.S. District Court for the District of New Jersey, held that no federal law requires set-aside arrangements in personal injury settlements for future medical expenses. The Court added that to require personal injury settlements to specifically apportion future medical expenses would prove burdensome to the settlement process and would discourage personal injury settlements. The Sipler Decision
Source: willshapiro.com

Why Many Find the Medicare Set

Like most governmental programs, most everyone involved in Medicare set-aside arrangements as they pertain to Workers’ Comp probably end up confused and anxious. The process, which allocates a portion of a worker’s settlement from Workers’ Comp to go toward future medical expenses can be very complex even for those who are regularly involved in it. Should there be a failure to give Medicare notice of a settlement, steep penalties could result. Further, Medicare is not allowed to make payments which are legally the responsibility of another party. Worst of all, the injured employee could find themselves ineligible for Medicare if all issues were not dealt with properly when the settlement occurred. It is recommended that a set-aside agreement be engaged in which takes a percentage of the settlement from Workers’ Comp for impending medical expenses; once this amount is gone—and accounted for—Medicare will kick in for the injured employee.
Source: joshilaw.com

I have a medicare set aside fund due to a very …

i have A MEDICARE SET ASIDE FUND DUE TO A VERY CRITICAL INJURY AT WORK.   THERE IS A GOOD AMOUNT OF MONEY IN THE FUND.  I HAVE NOT Had any real problems until my husband died.  i was not ale to live alone.  my injury was a brain injury and numerous oarts of my body were effected by it.  i had to move into an assisted living facility.  the money to pay for it was taken out of my personal needs trust.  i was told that i said thats where it should come from.  first of all i was not capable at the time to make that decision.  i thought there was a professional handling my account.  my mistake.  i am trying to get my money back into my personal needs trust. i have been told that medicare does not cover rehab facilities and assisted living so i am baqsicly out of luck and money.the frund was set up because of the accident.  i had to go to a living facility because of the accident. medicare told me that there is a cotingency plan that will get the money back from my set aside at spme point.  well, they will.  my set aside is set up to go to medicare when i die.  came close, but not in a hurry.
Source: askmez.com

NEW JERSEY COURT HOLDS MEDICARE SET

(1) plaintiff may require and undergo future medical treatment of injuries allegedly sustained in the accident; (2) acknowledge that the release is not intended to shift to CMS the responsibility for payment of medical expenses for the treatment of injury-related conditions;  (3) plaintiff warrants that he/she will use settlement proceeds received to pay for any future medical treatment and will not submit the bills for future medical treatment for injuries relate to the accident; and (4) plaintiff warrants that, to the extent that he/she is prohibited, by Federal law or regulation, from seeking payment from Medicare for treatment of accident-related injuries, he/she will not submit to Medicare any bills for future medical treatment for injuries arising out of the accident.
Source: themedicarespa.com

Medicare Secondary Payer and “Future Medicals” A Movement Toward a Standardized Process?

Posted by:  :  Category: Medicare

CMS states that its interests should be considered in every settlement where the claimant, “reasonably anticipates receiving, or should have reasonably anticipated receiving Medicare covered…services after the date of “settlement…”.  To accomplish this purpose, CMS proposes options  ranging from absolute exemptions on one end of the spectrum (i.e., CMS defined a set of circumstances in which no further action would be necessary / no “set aside” required) to alternatives on the other end of the spectrum that involve a) the beneficiary paying for all future injury-related care out of his/her settlement proceeds until they are exhausted or b) submitting a proposed Medicare Set Aside arrangement (similar to the current process in workers’ compensation).With regard to the latter options, it is important to note that CMS acknowledges that perhaps thresholds could be established (i.e., a dollar amount below which no action is necessary even if one of the other exemptions do not apply).
Source: dritoday.org

Video: 2010 Consultation Coding Medicare as Secondary Payer (MSP)

Medicare Secondary Payer (MSP) Program: Proposed Rules for the Treatment of Funds Intended for Future Medical Expenses 

[1] See 77 Federal Register 35917 (June 15, 2012), [CMS–6047–ANPRM].  [2] See section 1862(b) of the Social Security Act (the Act), 42 U.S.C. §1395y(b)(2)(Medicare Secondary Payer Program) http://www.ssa.gov/OP_Home/ssact/title18/1862.htm. [3] 42 U.S.C. §1395y(b)(2)(B). [4] 42 U.S.C. §1395y(b)(2)(B)(i). [5] 42 U.S.C. §1395y(b)(2)(B)(iv). [6] 42 U.S.C. §1395y(b)(2)(B)(iii). [7] For information about CMS activity related to MMSEA, see http://www.cms.gov/Medicare/Coordination-of-Benefits/MandatoryInsRep/index.html?redirect=/mandatoryinsrep/. [8] See §111, 42 U.S.C. §1395y(b)(8). [9]  See 42 U.S.C. §1395y(b)(8)(B). [10]  See 42 U.S.C. §1395y(b)(7). [11] See, Reporting Workers Compensation case information: https://www.cms.gov/Medicare/Coordination-of-Benefits/WorkersCompAgencyServices/reportingwc.html; set-aside arrangements: https://www.cms.gov/Medicare/Coordination-of-Benefits/WorkersCompAgencyServices/wcsetaside.html; coordination of benefits: https://www.cms.gov/Medicare/Coordination-of-Benefits/WorkersCompAgencyServices/WCMSAP.html. [12] In commenting, please refer to file code CMS–6047–ANPRM. CMS will not accept comments sent via FAX. Comments may be submitted electronically to http://www.regulations.gov; via regular mail (Attention: CMS–6047–ANPRM P.O. Box 8013, Baltimore, MD 21244–8013); express or overnight mail (Attention: CMS-6047-ANPRM, Mail Stop C4-26—5, 7500 Security Boulevard, Baltimore, MD 21244-1850; or by hand or currier (Room 445– G, Hubert H. Humphrey Building, 200 Independence Avenue SW., Washington, DC 20201., telephone (410)-786-1066 in advance of delivery by hand or currier.)
Source: medicareadvocacy.org

Love It or Hate It: Medicare Secondary Payer Enforcement Is Here to Stay

With regard to the Supreme Court, it remains unknown if it will take cert in Hadden. Does it have all the elements of a case ripe for cert? Absolutely. It is a federal question with conflicting decisions in the Sixth and Eleventh circuits and has a huge public policy component in the way it deters the settlement of insurance claims. The Court has already decided equitable apportionment with regard to Medicaid reimbursements in Ark. Dept. of Human Servs. v. Ahlborn (547 U.S. 268 (2006)) and on June 25, 2012, agreed to hear US Airways v. McCutchen (663 F.3d 671 (3d Cir. 2011)) which questions an ERISA plan participant’s obligation to provide full reimbursement to the plan administrator for medical expenses recovered from a third party. While each of these cases has entirely different legal aspects, the underlying issue in each is simply equity. Without some level of fairness, parties to insurance claims cannot resolve them without judicial intervention, and our judicial system cannot absorb this burden. Facing its own financial crisis, 60 federal court facilities in 29 states were considered for closing this year in an effort to reduce costs. It is assumed that the courts cannot absorb the burden of hearing only the medical component of claims that were otherwise voluntarily settled among the parties.
Source: lexisnexis.com

Understanding Medicare Secondary Payer

It is important to understand Medicare billing requirements which can be somewhat complex. Consider attending training events and opportunities. Providers must ensure that those responsible for preparing and submitting claims to Medicare are aware of proper submission guidelines and regulations. Knowing the answers to the following questions can help your billing process a lot easier.
Source: about.com

Medicare Secondary Payer Recovery Portal is Live

This Blog/Web Site is made available by the publisher for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog site you understand that there is no attorney client relationship between you and the Blog/Web Site publisher. The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.
Source: wordpress.com

New Online Medicare Secondary Payer Recovery Portal‏

The MSPRP gives users (attorneys, insurers, beneficiaries, and TPAs) the ability to access and update certain case specific information online. Activities that currently require written communication or telephone calls to the Medicare Secondary Payer Recovery Contractor will soon be able to be done through the portal.
Source: lienresolutiongroup.com

NEW JERSEY COURT HOLDS MEDICARE SET

(1) plaintiff may require and undergo future medical treatment of injuries allegedly sustained in the accident; (2) acknowledge that the release is not intended to shift to CMS the responsibility for payment of medical expenses for the treatment of injury-related conditions;  (3) plaintiff warrants that he/she will use settlement proceeds received to pay for any future medical treatment and will not submit the bills for future medical treatment for injuries relate to the accident; and (4) plaintiff warrants that, to the extent that he/she is prohibited, by Federal law or regulation, from seeking payment from Medicare for treatment of accident-related injuries, he/she will not submit to Medicare any bills for future medical treatment for injuries arising out of the accident.
Source: themedicarespa.com